LAUSR

Abstract Crash rates per mile indicate a high risk of vehicle crash in older drivers. A reliance on mileage alone may underestimate the risk exposure of older drivers because they tend to avoid highways and travel more on nonfreeways (e.g., urban roads), which present greater hazards. We introduce risk-exposure density as an index of exposure that incorporates mileage, frequency of travel, and travel duration. Population-wide driver fatalities in the United States during 2002–2012 were assessed according to driver age range (in years: 16–20, 21–29, 30–39, 40–49, 50–59, 60–69, ≥70) and sex. Mileage, frequency, and duration of travel per person were used to assess risk exposure. Mileage-based fatal crash risk increased greatly among male (relative risk (RR) = 1.73; 95% CI: 1.62, 1.83) and female (RR = 2.08; 95% CI: 1.97, 2.19) drivers from ages 60–69 years to ages ≥70 years. Adjusting for their density of risk exposure, fatal crash risk increased only slightly from ages 60–69 years to ages ≥70 years among male (RR = 1.09; 95% CI: 1.03, 1.15) and female (RR = 1.22; 95% CI: 1.16, 1.29) drivers. While ubiquitous in epidemiologic research, mileage-based assessments can produce misleading accounts of driver risk. Risk-exposure density incorporates multiple components of travel and reduces bias caused by any single indicator of risk exposure.